Gender-affirming hormone therapy and its impact on myocardial mass and cardiac function: a prospective magnetic resonance study on transgender men and women

Carola Deischinger; Dorota Slukova; Jurgen Harreiter; Stephan Nopp; Ivica Just; Martin Krssak; Siegfried Trattnig; Lana Kosi-Trebotic; Ulrike Kaufmann; Alexandra Kautzky-Willer

doi:10.1530/endoabs.99.EP15

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Endocrine Abstracts (2024) 99 EP15 | DOI: 10.1530/endoabs.99.EP15

ECE2024 Eposter Presentations Adrenal and Cardiovascular Endocrinology (155 abstracts)

Gender-affirming hormone therapy and its impact on myocardial mass and cardiac function: a prospective magnetic resonance study on transgender men and women

Carola Deischinger ¹ , Dorota Slukova ¹ , Jürgen Harreiter ¹ , Stephan Nopp ² , Ivica Just ³ , Martin Krssak ³ , Siegfried Trattnig ³ , Lana Kosi-Trebotic ¹ , Ulrike Kaufmann ⁴ & Alexandra Kautzky-Willer ¹

Err

Author affiliations

¹Medical University of Vienna, Endocrinology and Metabolism, Vienna, Austria; ²Medical University of Vienna, Hematology and Hemostaseology, Vienna, Austria; ³Medical University of Vienna, High field MR Centre of Excellence, Department of Biomedical Imaging and Image guided Therapy, Vienna, Austria; ⁴Medical University of Vienna, Department of Obstetrics and Gynaecology, Vienna, Austria

Background: The differences in cardiac parameters such as myocardial mass, left ventricular ejection fraction (LVEF), cardiac output, and brain natriuretic peptide (NT-proBNP) levels between cisgender men and women are well-established. However, no evidence exists regarding changes in myocardial mass or cardiac function parameters in transgender individuals undergoing gender-affirming hormone therapy (GAHT).

Patients and method: A prospective study enrolling 20 transgender men (TM) and 15 transgender women (TW) was conducted at the Medical University of Vienna from 2019 to 2022. A 3-Tesla electrocardiogram-gated magnetic resonance imaging was used to measure myocardial mass, LVEF and other cardiac function parameters before GAHT and at six-month follow-up. Myocardial lipid content was quantified using magnetic resonance spectroscopy.

Results: In TM, myocardial mass increased significantly after six months of GAHT from in mean (±SD) 48 (±8) g/m²; at baseline to 54 (±7) g/m²; at follow-up (P=0.011). TW showed a non-significant decrease of 4 (±14) g/m²; in myocardial mass. In both groups, no significant changes were noted in LVEF, stroke volume, cardiac output, or peak filling rate. Neither testosterone (TM: r=-0.127, P=0.679; TW: r=-0.127, P=0.679) nor estrogen levels (TM: r=-0.154, P=0.616; TW: r=-0.154, P=0.616) were related to myocardial mass at follow-up in either group. However, testosterone levels in TM correlated with cardiac output index (r=0.396, P=0.019), and in TW, with myocardial lipid content (r=0.579, P=0.007). Notably, NT-proBNP levels in TM were significantly reduced at follow-up (from in median (IQR) 41 (26-57) pg/ml to 19 (12-34) pg/ml). Myocardial lipid content decreased in transgender men but remained similar in transgender women at follow-up.

Conclusions: Myocardial mass increased while NT-proBNP levels decreased significantly in TM after six months of GAHT. However, no significant changes in cardiac function were noted in both TW and TM. Long-term studies are needed to better understand the cardiac effects of GAHT.